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02010069 TINO CITYUILDING DPEsiONPERMIT CONTRACTOR INFORMATION: BUILDING ADDRESS: PERMIT NO. MC CLELLAN RD CUPERTINO PLUMBING 02010069 rAdIWWNER*S NAME: APPLICATION SUB DATE CUPERTINO CITY OF 10297 S DE ANZA BLV 01/16/2002 ,?ONE: (408) 253-0618 SANITARY NO. CONTROL NO. 1 OC ARCHI=/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MICH r IJ L_I L .1 I--_I LICENSED CONTRACTOR'S DECLARATION �»� 1 hcrehv affirm that I am licensed under i rens t 9 uommenein Job Description z—c Bras Bions o per g ;mtW withscaion]i)001ofDi "sion3oftheBusinessandProcessionsCode.andmylicnse COPPER REPIPE F'e icefull force and�If cry l ��ps� �s o,a License Cl �� Lies Int C)S 1`® O i u Date "ti)_� Cammctnr 0� 13 a Gfi A CHITECT'5 DECLARATI N u O 4 1 understand my plans shall he used as public atoms ✓ Q 2 2002 S:ps v LJ Cf Licensed Professional - OWNER-BUILDER DECLARATION 1 hereby affi.secttha 11. exempt from the Contractor's :Anyc taw for the whcfollowing a a.Permit t 7031.5,Business also Pm.de oli Code:Any my or eaanry BVU,.DIN 0 0 0 F x e which requirta pernit m mmwn,alter,improve,demolish,Or repair any structure ata" pnorto its issuance,also requires the up0linnt for such permiHo 11,o signed statement Oita 3 Not M is licensed pursuant to the provisions of the Contractors Lice a law(Chapter 9 u (commencing with S'ecdDB0 oo] )o1 Division 3 of the Business and Professions Code) VaIUBhOn or that he is exempt therefrom and the basis for The alleged exemption.Any violation of Section 7031.5 by any applicomt for a permit subjects the applicant to o civil Penalty 1 of not mom than five hundreddollars(s500). 20y1%LNS1MRFLOOR PLUMBING Occupancy Type ❑1,as owner of the property.or my employees with wages as their sole compewtion. will do the work,and the structure is not intended or offered for sale(Sec.]044, Business and Professions Code:The Contractor's License Law does not apply to an 502 - FINAL HZfe41lhWNQ)e9WRRGY' owner of property Who buthis or impruves thereon,and who does such work himself or throech his own employees.Provided that such improvcmenTs am not intended or 50.7 - FINAL PLUMBING _ offered sale.If,however,the building or improvement is sold within one your of " ompletion.The owtursotilder will have The burden of proving that he did not build or imPmve fm pmrpose f.1c.). co I,as ct the pr The Pmpery,um exclusively d Professions with odenwa a Coacmrs To construct The projsxt(Sec.]IW4,Business and Professions Calctl The Convector's Liceme Lew tat nm apply t pan owner with a comm who builds or improves to the -and who 's Livens for such projects with a conwna(s)licensed purwam to The ... .. _. .. .. 01..Contrainc License Law. ., ❑I am incept under Site ,B&P C for this reason ter Data WORKER'S COMPENSATION DECLARATION 1 hereby aRTmr under penalty of perjury ane of the following dalismtimee i 1 have and will maintain a Corticate of Conant to self-insure for Worker's Compensation, as provided for by Section 3700 of the Labor Code, for The pasfomunce of the work for which this permit is issued. .. Cl 1 have and will maintain Worker'.Cuntansmiom Ir svmce,as required by Section 3700 of the Labor Code.for the Performance of The work for which this permit is . ( issued.My Workers Compensation Insurance carver and Policy number aa: Carrier.S�.,y O Policy No: 13 I LBIT OL'21C)�. - CERTIFICATION OF EXEMPTION FROM WOR ERIC 5" - . COMPENSATION INSURANCE ._ _ .. . .., .. -. (This seniors aced not W completed if the pamrit is for ane handed aollm (S10()Orless.) I eerily that in The performance of the Lek for which this permit is issued.1 shall as employ any pavan nany manner so m to hcomc subject m the Workers' an Can Laws of Colifnmia,Dnte Applicant NOTICE TO APPLICANT.orers ftcrmaking his Consortium of Exemption.youshould - � EecamesubjectcooneWorker's,limn I tion provisionsll thelabor Cale,you must I forthwith comply with such provisimna ar This permit shall be deemed mvokM. ,r W)k CONSTRUCTION LENDING AGENCY ai'7 1 .1 I hereby affirm that chert is a construction lending agency for The peAosmaner W of the work for which this permit is issued(Sec.3097,Civ.C,) 0. Q Lender's Nome r7,z Lender's Addeo V0 1 certify that T have read This application and state that the above inmrtm iati is l,, tarda.I agree to comply with all city and county ordinances and stmt lows relating U W dleIWingmnsudctioganahcminspeconurcpeasenmtives of thiscity to enter upon t� tM abo(We) rte ti.p o.indemnify for inspection pugsoxa. [.w d I We)agree to save,indemnify and keep h may in the City of count a against against W city in co judgments,casts and expenses which may in any way account ogainat soil U Z Airy in consequence R the NDS AND D Nis permit. •�� APPLICANT REGULATIONS. AND\VILE COMPLY x'ITHALL'N'ON-POINT Issuedb �s Date SOURCE REGULATIONS. y' Signature of ApplicanVCimranor Data Re-roofs HAZARDOUS MATERIALS DISCLOSURE ` Willthe it linnt or mea housing acupvnt cadre ar Imrkle hmemaus material .. Type of Roof .. .. ... .. -. . as defined by the Cupertino Municipal Code,Chapter 9.12.and the Health and Safety Code.Section 35532m)? , °PeS � t All roofs shall be inspected prior to any reofing.material.being installed. - Will the applicantorfuture buildingacupmnuse equipment ordevicaswhich If a roof is installed without first obtaining an inspection, I agree to remove Wit hazardous air conemintim,codefined by the Bay Amx Air Quality Management -isuictl all new materials for inspection. Applicant understands and will comply with Duca v�Na_: 1. all non-point source regulations. 1 have read the boos us mamrials rcyuiremenls under Chapter 6.95 of the , California Health k Safety Code,Sections 35505,25533 and 25534.1 understand That if the building does not currently have is Tenant,that it is on,responsibility to notify the aceanT of the requirements which must W met prior to issuance of a Certificate of 'I'""1`,ft�6`✓ � Signature of Applicant Date Os�shct&outhonzed agen, Date All roof coverings to be Class "B" or better CITY I UUI OF DPERTONNO CONTRACTOR INFORMATION: PERMIT BUILDING ADDRESS: PERMIT NO, MC CLELLAN RD CUPERTINO PLUMBING 02010069 OWNER'S NAME: APPLICATION SUB DATE CUPERTINO CITY OF 10297 S DE ANZA BLV 01/16/2002 / ONE (408) 253-0618 SANITARY NO. CONTROL NO. n p0 0 ARCHITECTIENGINIJdR: BUILDING PERMIT INFO - BLDG ELECT PLUMB MECH a i G IJ a L._1 I--_I G. to w LICENSED CONTRACTOR'S DECLARATION = 1 hereby arfirm mm I am Teenxm anger pm+ixanr,nrcnapter 9 mnnrmetteirg Job Description u; withge COPPER REPIPE is in full force andr d C A6iz�6 Licnu Cl s� Conte :o i Lu Date Contractor 3 o G A CHITECI'I DECLARATI N g1 understand my plans 0,11 he axed as pablie accords a c O Licensed 1'rofelional i a OWNER-BUILDER DECLARATION I hereby that I am exempt from the Co s License Law for the z following reason..(Swrian 7031.5.Business and Proestions Code: Any city or roomy $4000 i F a which 1equirics a entil contract, improve demolish, p y smuctum de ons am,tons < 1 accruesbe p[,IYom mrsuch perm)looa..x,ocd statement ...... _._ . - e 3- ,bar be io ficantod Runner to the Pro on.of the Conuoctm s Licer.Lu (Chapter 9 - - formaim otegwathSeche 91)(0)ofDivision 3.1the Business aadProfessions Cods) 3 '' Ar��;•, - Valuation or that he is exempt therefrom and the basis for the alleged exemption.Any violation or Section 7831:5 by any opplicom for u permit moide,be applicant..a civil penalty 'mammon,than five handmddollars($5no). 20`�N_NMfttRFLOOR P UMBING Occupancy Type °1,as notice of the progeny,or my employees with wages as their sole compensation, will do the work.end the structure is not intended or oftmd for sale(Sec.70,l Business and Professions Cmc:The Contractor,License Law does not apply to an 502 - FINAL HZfo d NQ)e9Wi9RGY' owner of propcny Who builds or improves thereon,and who does such work himself 507 - FINAL PLUMBING _ or erect R his own employees,provided n that such improvements is of a i not intended or ' offered I'or sole.IL nnwmcr;lM1e builJin tis soW within one af g or improvcmen Yild o .prove for the ownenhtiilder will have me burden of proving that be did not build or improve for Propose of soled. -e ..__'_ °I;ns owner of the pmpeny,am exclusively commning with liccnud mmmaurs to construct the project(Sec.9044,Business and Professions Code The Comracur's • . License Luo does nm r such ue man owner of a can y wbn builds scimp ass a thereon, and who commas for zuch.projens with a contracmds)liccnud pursuant 4u the Contractor's License Law. ❑l am exempt under Sec. .B&PCfar this..an yx _ Owner Date piiv q 1. WORKER'S COMPENSATION DECLARATION V9 �® I hereby vRms under penalty of perjury oar of,hc following declaations: r rr� . 1 have and will maintain'a Cenificam of Consent w self-insure for WorJHker's 2 G O 2 002 Comgensation, as provided for by Section 37M of the Labor Code, for the perfommnce rthe work it,,which this permit is issued. �� .. °1 have and will moiniain Worker's Compensation Insurance,as required by Section IC D,/k,w 31(0 of the Labor Code,for the Performance of rhe work for which this permit is IVG issued.My Workers Comgcnsmion Insurance carrier and Policy number am: "ec- ` -' ' t'1`'`Policy N., 37llnfr ay�G Cart 1 CER'rIFICATi OF E%CMPTION-FROM WOR ESC RS"—� k - .- COMPENSATION INSURANCE rection Aced not be completed if the permit is for one hundre fhiz sd dollars IS W)nr I<s6.) I<mify rhm in the performance of the work fur s Jr i ibis genii is issued,i - _~- - - - - •- -. tsball not employ any perion in any manner to u ro become iubjcet to the Workers Compensation Lows of Califomia.Date ANdicion 'NOTICE TO APPLICANT:If,afar making this Cenifieare of Exemption,you should ` become subject lobe Worker's Compuuation pd,i+airs of the LaMar Code,yno must O forthwith comply with such provisions or this permm it shall be deeed revoked. F - - - CONSTRUCTION LENDING AGENCY ^ - - - - - '- a,7 ' I hcrchy affirm Ibat there is a construction lending agency for the performance W cf rhe work for which IM1is'permil is issued ISec 71N9.Cil C QLender's Name Z Lender's AJdrcs, . CJ 1I agree that 1 have teed ails application and,mm antes a above homesteader W E. conoid I agree to comply a with all city am county ordinances and,rare lees relating V the ailJingmnsWed construction,andfor i apection paprcsenmtivo of this to enter upon [x7 the above-mentioned Progeny enr y and p formle Cupertino 1 W's)agreeto.cost indemnifydad keephamyinthe City ofcruagainst against U 0liabilities,itno judgments costs and gex ranting of do which may in any wry accrue against said nsequence of tc ^ 'SOURCEREGUL TIONSNUSAND WILL COMPLY N'ITHALL'h'ON-POINT Issued by: Date , SOURCP.REGULATIONS. � 'Signature of ApplicanVCnmracmr "" Date Re-roofs HAZARDOUSMATERIALS DISCLOSURE , Will the applicatn tri furore beilding dmupmd same or handle hazvdmer mmmial Type of Roof.. - -•- - - - — _-as de,radby the Cupeninn Municipal Code,Chapter 9.12,and the Health and Safety Cate.Section 8532109,,q;'i 'hss•r.'R`n`r.` •:. t y,. .. °Y" ' All ro/ofs.shall be inspected prior to any roofing.material-being.installed., wal me aPPu<am oe mrpre waei�a ne<aganl a+e�gaiprremmae.a<ea whoa If a roof is installed without first obtaining an inspection, I agree•to remove it hazardous art c�at. racts u refined by the Bay Area Air Quality Muagemem 6Gian ,. all new materials for inspection. Applicant understands and will comply with . lipore, + u,rte N__ all non-point source regulations. I have read the harnrcmi�Iwmrials mquircmetns under Chapter 6.95 of the _ Califomia Hnllh&Safety Code.Sectim,255¢5.2553J and 8534.1 understand that if the building dee,not currently have a tenant,that it is my responsibility to notify the , t of the requirements which must be met prior to issuance of a Certificate of Si nature of Applicant Date rate alf`���'_p Z g PP ow rhonud agent ' ' Date All roof coverings to be Class"B"or better .._ . . _ . .. OFFICE .. ..